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Water Security and Sanitation - Year 2

Lecture Notes

TOPIC 1 – WATER & WASH OVERVIEW - WATER CYCLE & DISTRIBUTION, WASH,
HEALTH, AND SOCIAL ISSUES ASSOCIATED WITH WATER, SANITATION, AND
HYGIENE (WASH)

THE WATER CYCLE

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Lecture Notes
WATER RESOURCE DISTRIBUTION
From outer space, the earth looks like a "blue" planet because most of its surface is covered by water.
The earth’s surface is covered by more than 7o% water. The vast majority is in the oceans and is unfit for
human consumption. Most of the freshwater is locked up in the ice caps and in glaciers. Usable, available
freshwater, in the lakes and rivers on the surface and in the underground reservoirs, is less than one percent
of the total water in the world. The table below shows the distribution of the water resources on the earth’s
surface.
Water Body Percentage (%)
Salt water in oceans 97.2
Ice caps & glaciers 2.14
Groundwater 0.61
Soil moisture 0.005
Atmosphere 0.001
Fresh surface water 0.0009
Table 1 – The distribution of the world’s water
Due to a mix of geographical, environmental, and financial factors, as well as to increased pollution from
municipal and industrial waste, the leaching of fertilizers and pesticides used in agriculture, only about
one-third, of the world’s potential fresh water can be used for human needs. As pollution increases, the
amount of usable water decreases. Water contributes much to health. Good health is the essence of
development. However, water’s protective role is largely unseen and taken for granted in the wealthier
countries. More attention is paid to it role in disease transmission than health protection. Water
contributes to health directly within households through food and nutrition, and indirectly as a means of
maintaining a healthy, diverse environment. These two precious resources — water and health —
together could enhance prospects for development.

WASH
WASH is the acronym for Water, Sanitation and Hygiene. Due to their interdependent nature, these
three core issues are grouped together to represent a growing sector. While each a separate field of
work, each is dependent on the presence of the other. For example, without toilets, water sources
become contaminated; without clean water, basic hygiene practices are not possible. Access to water
and sanitation is one of the major challenges for the 21st century. World Health Organization (WHO)
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Lecture Notes
estimates that still "2.5 billion people- more than one third of the global population – live without basic
sanitation facilities".

In 2015, 750 million people lacked access to safe, clean drinking water and approximately 2,300
people die every day from diarrhoea. Water is not only an important factor of public health, but also
of general livelihoods and development: crop production, livestock production, industry, commerce,
and daily life depend on access to water. Water-supply and sanitation conditions therefore directly
affect health and social issues; gender issues, inequality, and food security which is a key component
in the fight against Hunger and Malnutrition.

In recent decades, the need for a global agenda for the improvement of water, sanitation, and
hygiene have been an important issue in various world fora. Two notable ones are the Millennium
Development Goal (target 7) which proposed a global reduction by halve of access to water and
improve sanitation by 2015 and this was succeeded by the Sustainable Development Goal six (6)
which also declared the affordable access to water and better sanitation by 2030.

WASH AND HEALTH

The poor are more susceptible to ill-health than are the well-off. They lack adequate supplies of safe water
and safe methods of disposing of their wastes. Lack of water and sanitation create ideal conditions under
which faecal oral diseases thrive. Study after study has shown that where a community improves its water
supply, hygiene and/or sanitation then health improves. For example, diarrhoea can be reduced by 26%
when basic water, hygiene and sanitation are supplied. Yet statistics tell a terrible story. The World Health
Organization says diarrhoeal diseases remain a leading cause of illness and death in the developing world.
Every year, about 2.2 million people die from diarrhoea; 90% of these deaths are among children, mostly
in developing countries (third highest killer). A significant number of deaths are due to a single type of
bacteria, Shigella, which causes dysentery or bloody diarrhoea. It is readily controlled by improving
hygiene, water supply and sanitation. Although no vaccine exists and antibiotics may be inaccessible to
many people, an effective intervention is available. The simple act of washing hands with soap and water
reduces Shigella and other types of diarrhoea by up to 35%.
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WASH AND SOCIETY (SOCIAL ISSUES)
Also, in many developing countries, inadequate water supply and poor sanitation are disturbing the social
fabrics of the community. For instance, studies have showed that lack of these facilities may cause children
to drop out of schools, early pregnancy, inequality and gender issues at the community, and the
productivity of the population is reduced due to useful time is being spent fetching water or illness from
water related diseases.
These compounded problems can exacerbate poverty and under-development in the rural communities.
Poor communities are often forced to over exploit their natural resources in order to survive. Water
sources are particularly vulnerable. In too many cases, they are abused to such an extent that they no
longer can provide for a community’s basic needs and end up posing serious health risks and social
problems.
However, opportunities for reversing this situation exist. What is required is that priority is given to water,
sanitation, and hygiene management and development and that communities play a major role in solving
their own problem. This will entail the full involvement of communities in the planning and development
of their own water systems. Gross inequities in the reliability and quality of water supply services create
a market for water-vendors and encourage use of unsafe local wells and springs in urban slums. Similar
inequities in access to safe water, especially in rural areas, force women and children in developing
countries to spend hours every day fetching water, causing an enormous drain on their energy, productive
potential, and health. The lack of good quality, reliable water puts people’s health at risk and may force
them to extract water from alternative, unsafe sources, exposing them to diseases such as diarrhoea or
dysentery, cholera, typhoid, and schistosomiasis. Traditional wells may become polluted with
agrochemical residues as irrigated agriculture intensifies.
The gap between rich and poor becomes all too apparent in regard to the lack of water for drinking,
irrigation, and sanitation, and in their inability to maintain the integrity of ecosystems on which people
depend. Time and again, poor people everywhere – in Sierra Leone, Bangladesh, Viet Nam, Kyrgyzstan,
Malawi, etc.– cite lack of safe drinking-water as one of their most important problems.
Everyone benefits from good sanitation. But girls are among those who benefit the most. Girls often miss
out on an education because they have to help with the household chores and, when money is scarce, it’s
usually the boys who get chosen to go to school. An important reason why girls drop out of school in
developing countries – mainly in Africa and Asia – is because of lack of sanitation facilities. Studies show
that school attendance by girls increases when separate latrines for girls and boys are installed. In a school
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Lecture Notes
in Bangladesh, where UNICEF began promoting separate facilities in 1992, girls’ school attendance has
risen by an average of 11% a year.

TOPIC 2 - DISEASE TRANSMISSION AND WASH INTERVENTION

The F-diagram concept-Disease transmission route
There are multiple routes through which faeces can be consumed and cause disease.
The diagram below which is known as the ‘F-diagram’ illustrates the relationship between
faeces, flies, food, fluids, feet? and fingers as routes of transmission of diseases. It shows
how faecal matter gets to our mouth through the different routes and the ways of breaking
the transmission cycles. The green lines indicate places where onward transmission can be
prevented through improved sanitation and hygienic behaviours.

Figure 1 – The F-Diagram illustrating the transmission route of E-coli (disease

diarrhoea causing bacteria)

Using the diagram, we can see that the most important way of preventing spread of
diarrheal diseases are:
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Lecture Notes
• Proper disposal of faeces through use of pit latrine (Flies, fluids, fields)
• Proper hand washing with soap or ash at the critical times (Fingers, food)
• Drinking safe and clean water (fluids)
• Treating water by boiling or use of chlorine tablets (fluids)
• Covering food and water (Flies, Fluids)
• Proper cooking of food (Food)
• Providing general health education on water, sanitation, and hygiene promotion with
emphasis on food hygiene, personal hygiene, environmental hygiene
• Protecting water sources and storage tanks by fencing, providing lids, repair of
leakages and broken pipes (fluids)
• Cleanliness around water collection points and draining of waste/dirty water (fluids)

Classification of Diseases related to Water, Sanitation, and Hygiene

There are many diseases that are associated With poor water, hygiene, and sanitation
practices and improper management of liquid and solid waste. The most common diseases
are diarrheal diseases transmitted by human excreta (also known as faeces or stool)
containing harmful organisms that come into contact with people through touching of faeces,
eating food contaminated with faeces and drinking of contaminated water. In addition, some
diseases are prevalent due to poor management of water. The sections below will discuss the
risk factors associated with poor practices around water, sanitation, and hygiene, and how to
prevent them.

1.Water borne diseases: Diarrheal diseases contribute largely to child mortality and
morbidity globally. They pose a particular risk especially in refugee camps where
infrastructure is poor, and many people may be suffering from malnutrition. These diseases
result when water, food or fluids is contaminated with pathogens, commonly from faecal
matter. Diseases that are contracted as a consequence of consumption of unsafe water may
lead to diarrhea and loss of fluid in the body causing dehydration and malnutrition. Water
borne diseases include diarrhoea, cholera, amoebiasis, Typhoid & bacillary dysentery and
Hepatitis A. Prevention and control is through treating water prior to drinking it and proper
food, water, and environmental hygiene.
2. Vector-borne diseases: Vector-borne diseases are spread by biting insects, such as
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Lecture Notes
mosquitoes, sand fly or tsetse fly that rely on water for breeding. Diseases spread from
these bites include malaria, yellow fever, river blindness and filariasis, among others.
Filariasis and malaria are spread by mosquito vectors. Onchocerciasis is spread by the
black fly that breeds in fast flowing water and leads to river blindness. Schistosomiasis or
Bilharzia, which is transmitted by infected snails that live in reeds along rivers and lakes, is
caused by a parasitic worm infection. It causes swollen stomach, tiredness, poor growth and
development in children, and later in life more severe complications caused by fibrosis of the
affected organs. Snails are infected from people who have an infection defecating or urinating
near to a water source where snails live.

Prevention and control of these vector borne diseases is through draining stagnant water,
indoor residual spraying (IRS), larviciding and sleeping under Long Lasting Insecticide Treated
Nets (LLITNs). In the case of onchocerciasis, active removal of fly breeding sites is required.

3.Water-related diseases: These diseases are due to lack of sufficient safe water. Diseases
that fall under this category include trachoma, scabies, and skin infections.
Trachoma is a bacterial infection of the eye and can lead to blindness if not treated. It is due
to not washing the face and not keeping the household environment clean and free from flies.
Prevention is by ensuring enough water is available for proper washing and ensuring good
personal and environmental hygiene.